How to Use Naloxone Nasal Spray for Opioid Overdose: Step-by-Step Guide

In 2022, over 81,800 people in the U.S. died from opioid overdoses. But with naloxone nasal spray, you can reverse an overdose in minutes-no medical training needed. This guide walks you through exactly what to do.

Naloxone nasal spray is a life-saving medication designed to quickly reverse opioid overdoses by blocking opioid receptors in the brain. Approved by the FDA in 2015 and made available over-the-counter in 2023, this single-use device delivers a precise 4 mg dose (3.8 mg of active ingredient) in a 0.1 mL volume. It starts working within 2-5 minutes and has a shelf life of 24 months when stored at room temperature.

Recognizing an opioid overdose

Before administering naloxone, you must confirm it’s an opioid overdose. Look for these signs: slow or no breathing (fewer than 12 breaths per minute or no chest movement for 15 seconds), unresponsiveness to voice or sternum rub (knuckles on chest bone), pinpoint pupils, and blue or pale skin. The CDC states that slow or absent breathing is the most critical symptom-without oxygen, brain damage can occur within minutes.

Remember: naloxone only works for opioids. It won’t help with overdoses from alcohol, benzodiazepines, or other substances. But if you’re unsure, administer it anyway-there’s no harm in using naloxone when opioids aren’t present.

Call emergency services first

Before doing anything else, call 911. The Substance Abuse and Mental Health Services Administration (SAMHSA) emphasizes that emergency medical help is always needed, even if naloxone works. Paramedics can provide further care once the person starts breathing again. Give the operator the location and that someone has overdosed on opioids.

Step-by-step administration

Follow these steps exactly:

1. Position the person on their back with head tilted back to open the airway. The Mayo Clinic recommends this to ensure the spray reaches the nasal passages effectively.
2. Remove the naloxone nasal spray from its packaging. Do not activate it until ready to use-improper handling can waste the dose.
3. Gently insert the nozzle into one nostril until your fingers touch the bottom of the nose (about half an inch to one inch deep).
4. Press the plunger firmly until it clicks. This delivers the full dose. The Canadian Centre for Occupational Health and Safety found that 18% of first-time users don’t fully depress the plunger, reducing effectiveness.
5. Wait 2-3 minutes. Check for normal breathing (12-20 breaths per minute) and responsiveness. If there’s no improvement, administer a second dose in the other nostril using a new spray.

After administering naloxone

Once the person starts breathing:

• Place them in the recovery position (on their side) to prevent choking. The American Heart Association recommends this for unconscious individuals.
• Stay with them until paramedics arrive. Monitor for returning overdose symptoms-opioids like fentanyl may outlast naloxone’s effects.
• Do not leave them alone. The CDC reports that 32% of fentanyl-involved overdoses require two or more naloxone doses for reversal.

Common mistakes and how to avoid them

Many reversals fail due to preventable errors:

• Not calling 911 first: Emergency services are always needed. Naloxone is temporary support, not a replacement for medical care.
• Incorrect nozzle insertion: Inserting too shallow or too deep reduces absorption. Practice with a training device to build confidence.
• Partial plunger press: Only 82% of first-time users fully depress the plunger. Listen for the click to confirm full delivery.
• Misidentifying overdose symptoms: The Massachusetts Department of Public Health reports 31% of failed reversals stem from this. Learn the signs: slow breathing, unresponsiveness, blue skin.

Free training is available nationwide through over 12,000 community organizations. The CDC says 92% of people master proper technique after 15 minutes of practice.

Frequently asked questions